MRI more sensitive and cost effective compared to CT scan in stroke patients

USA: Using Magnetic resonance imaging as the first scan over CT for suspected stroke leads to better outcomes and also saves money by overcoming the unnecessary admissions, according to a recent study.

According to the review, presented at the annual meeting of the American Neurological Association, getting Magnetic resonance imaging first for suspected stroke leads to sooner definitive diagnoses and helps to manage the person more appropriately and rapidly without negatively affecting the outcomes even in stroke patients who receive endovascular therapy.

A stroke is caused by the interruption of the blood supply to the brain, usually, because a blood vessel burst or is blocked by a clot, according to WHO. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.

Based on the results, Argye Hillis, director of the Center of Excellence in Stroke Detection and Diagnosis at Johns Hopkins University, Baltimore, and colleagues recommend skipping the CT and getting a Magnetic resonance imaging,while they are still in the emergency room.

According to the researchers, almost all emergency departments in the US are set up to get a CT first, but MRI is known to be the better study.

MRI is much more sensitive to stroke, especially in the first 24 hours, and pinpoints the location and extent of the damage. It can detect causes of stroke invisible to CT, with no radiation, and rule out stroke entirely, whereas CT can rule out only intracranial bleeding. Increasingly in Europe, MRI is the first study in suspected stroke, and new EDs in the United States are being designed with an in-house MRI, or one nearby.

The researchers reviewed 320 patients with suspected ischemic stroke had CT in the ED at Hopkin's, and then definitive diagnosis by MRI, which is the usual approach in most of the US hospitals.

A total of 134 patients had a final diagnosis on MRI that did not justify admission; techs were available to give 75 of them MRIs in the ED after the CT, and those patients were sent home. Techs were not available, however, for 59 patients and since the CT was not able to rule out stroke, those patients were admitted. The cost of those 59 admissions was $814,016.

Key findings include:

The cost of the noncontrast CTs for the 75 patients who were sent home after definitive MRI imaging was $28,050, plus an additional $46,072 for those who had CT neck/head angiograms.

Altogether, skipping the CT and going straight to the MRI would have saved Hopkins $888,138 in 2018, enough to cover round-the-clock MRI staffing in the ED, which is now the plan at the main campus.

Stroke mimics among the 134 patients included peripheral nerve palsy and migraine, but also people simply faking it for a hot meal and a warm bed. “It's pretty common, unfortunately,” said Hillis.

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